Background
Many patients with hypertension require more than one drug to achieve blood pressure control. They are prescribed with fixed-dose combination (FDC) antihypertensive therapy rather than ...monotherapies. Although it is commonly admitted that the use of FDC may improve compliance to treatment, adherence rates in patients receiving FDCs have not been documented. Therefore, the aim of this study was to assess the adherence to treatment in patients receiving FDCs of antihypertensive medications in a real-world setting in Egypt.
Results
We conducted a multi-center cross-sectional study over a period of 1 year from Jan 2017 to Jan 2018. We included patients above 21 years old with essential hypertension who were already prescribed with an FDC of antihypertensive treatment for at least 3-month duration. We assessed the adherence to treatment by patient self-assessment using the Morisky 8-Item Medication Adherence Scale (MMAS 8).
This study enrolled 2000 hypertensive Egyptian patients. The mean age of enrolled patients was 55.8 ± 10.9 years. Male to female ratio was 1.08. The mean MMAS score was 6.5 ± 1.9. Our analysis showed that 825 (41.3%) patients reached high adherence score, 523 (26.2%) medium adherence, and 652 (32.6%) low adherence.
Furthermore, Male patients showed higher adherence rate than females (56.4% versus 43.6%,
p
< 0.001). Out of 746 patients with controlled blood pressure (< 140/90), 387 (51.9%) patients were highly adherent to treatment. Higher level of education was significantly associated with high adherence rate; 559 (67.8%) patients were university graduates, 232 (28.1%) had primary/secondary school education, and 34 (4.1%) were illiterate (
p
< 0.001).
Moreover, once daily (99.2%) fixed-dose combination was associated with higher adherence rate than twice regimen daily (0.8%),
p
= 0.03. Multivariate logistic regression analysis showed that patients with high level of education, employed patients, and patients with controlled blood pressure have high adherence rate to medication.
Conclusions
Higher adherence to medication is associated with high level of education and employment, and it can lead to better blood pressure control. Thus, patient education programs may increase patients’ adherence to their medication.
Heart failure is a global public health problem, affecting a large number of individuals from low-income and middle-income countries. REPORT-HF is, to our knowledge, the first prospective global ...registry collecting information on patient characteristics, management, and prognosis of acute heart failure using a single protocol. The aim of this study was to investigate differences in 1-year post-discharge mortality according to region, country income, and income inequality.
Patients were enrolled during hospitalisation for acute heart failure from 358 centres in 44 countries on six continents. We stratified countries according to a modified WHO regional classification (Latin America, North America, western Europe, eastern Europe, eastern Mediterranean and Africa, southeast Asia, and western Pacific), country income (low, middle, high) and income inequality (according to tertiles of Gini index). Risk factors were identified on the basis of expert opinion and knowledge of the literature.
Of 18 102 patients discharged, 3461 (20%) died within 1 year. Important predictors of 1-year mortality were old age, anaemia, chronic kidney disease, presence of valvular heart disease, left ventricular ejection fraction phenotype (heart failure with reduced ejection fraction HFrEF vs preserved ejection fraction HFpEF), and being on guideline-directed medical treatment (GDMT) at discharge (p<0·0001 for all). Patients from eastern Europe had the lowest 1-year mortality (16%) and patients from eastern Mediterranean and Africa (22%) and Latin America (22%) the highest. Patients from lower-income countries (ie, ≤US$3955 per capita; hazard ratio 1·58, 95% CI 1·41–1·77), or with greater income inequality (ie, from the highest Gini tertile; 1·25, 1·13–1·38) had a higher 1-year mortality compared with patients from regions with higher income (ie, >$12 235 per capita) or lower income inequality (ie, from the lowest Gini tertile). Compared with patients with HFrEF, patients with HFpEF had a lower 1-year mortality with little variation by income level (pinteraction for HFrEF vs HFpEF <0·0001).
Acute heart failure is associated with a high post-discharge mortality, particularly in patients with HFrEF from low-income regions with high income inequality. Regional differences exist in the proportion of eligible patients discharged on GDMT, which was strongly associated with mortality and might reflect lack of access to post-discharge care and prescribing of GDMT.
Novartis Pharma.
Introduction
Anterior distal femoral hemiepiphysiodesis using intra-articular plates for correction of pediatric fixed knee flexion deformities (FKFD) has two documented complications: postoperative ...knee pain and implant loosening. The aim of this study is to investigate the mechanical properties of a novel extra-articular technique for anterior distal femoral hemiepiphysiodesis in patients with FKFD and to compare them to the conventional technique.
Materials and methods
Sixteen femoral sawbones were osteotomized at the level of the distal femoral physis and fixed by rail frames to allow linear distraction simulating longitudinal growth. Each sawbone was tested twice: first using the conventional technique with eight plates placed anteriorly just medial and lateral to the femoral sulcus (group A) and then with plates inserted in the proposed novel location at the most anterior part of the medial and lateral surfaces of the femoral condyles with screws in the coronal plane (group B). Gradual linear distraction was performed, and the resulting angular correction was measured. Strain gauges were attached to the plates, and the amount of strain (and equivalent stress) over the plates in response to linear distraction was recorded. The two groups were compared using the Wilcoxon signed-rank test.
Results
The amount of angular correction was statistically higher in group B (extra-articular plates) at 5, 10-, and 15-mm of distraction (
p
< 0.001). As regards stress over the plates, the maximum stress and the area under the curve (sum of all stresses measured throughout the distraction process) were significantly higher when the plates were inserted at the conventional position (group A) (
p
< 0.001).
Conclusions
During anterior distal femoral hemiepiphysiodesis, the fixation of the eight plates in the coronal plane at the anterior part of the femoral condyles may produce a greater amount of correction and a lower degree of stress over the implants as compared to the conventional technique.
The purpose of this study was to explore the effects of roasting linseeds on the pigment, lipid profile, bioactive components, and oxidative stability of the extracted oils. The linseed varieties ...Giza 11, Giza 12, Sakha 3, and Sakha 6 were roasted at 180 °C for 10 min, and the oils were extracted by cold pressing. The results showed that, after roasting, there was an increase in oil percentage and peroxide value, as well as small increases in
-anisidine and acid values. Roasting also caused an increase in chlorophyll content, while lutein and β-carotene tend to slightly decrease, except in the Giza 11 variety. The total phenolics content was markedly enhanced after roasting. Omega-3 fatty acids were not affected by the roasting process. The total amounts of tocochromanol were found to decrease in the Giza 12 and Sakha 6 varieties after roasting. Plastochromanol-8 increased in all varieties after roasting. The phytosterol composition was minimally affected by roasting. Roasting enhanced the stability of the extracted oils, increasing the induction period and decreasing EC50 values. These results may thus help to discriminate between the different linseed varieties and serve to recommend the use of roasting to enhance the oxidative stability of extracted oil.
The study explored the catalytic activities of chitosan-supported tetra (
p
-methoxyphenyl) porphyrin complexes
1–3
in the heterogeneous activation of the aerobic oxidation dimerization of ...2-aminophenol (OAP) to 2-aminophenoxazine-3-one (APX) in the presence of bicarbonate, simulating the function of phenoxazinone enzyme synthase. The oxidation reaction was followed by recording the UV–vis spectra of the reaction mixture with time at
λ
max
433 nm. All chitosan-supported metalloporphyrin complexes
1–3
exhibited effective catalytic activities for OAP oxidation. Under optimal conditions, the chitosan-supported Cu(II) (T
p-
OCH3
PP) complex displayed the highest catalytic efficiency. Various parameters influencing the catalytic activity of Cu(II) (T
p-
OCH3
PP)/CTS
1
were studied. The observed rate constant of OAP oxidation exhibited a direct correlation with the concentration of supported catalyst
1
and followed Michaelis–Menten kinetics, indicating saturation of catalyst sites with increasing OAP concentration. The study investigated the impact of temperature, bicarbonate concentration, dissolved oxygen, and the reaction mechanism. Oxidation reaction of OAP catalyzed by
1
in the presence of nitro blue tetrazolium (NTB) revealed no superoxide anion O
2
−•
was formed as a reactive species during the reaction. The chitosan-supported Cu(II) (T
p-
OCH3
PP) complex shows high catalytic stability and no significant changes up to the fifth run.
Background
Regional level data on hospitalized heart failure (HHF) patients in Egypt is scarce. The aim of this study was to compare the demographics, clinical characteristics, and outcomes of HHF ...patients from four distinct geographical regions of Egypt.
Results
Study participants were part of the European Society of Cardiology Heart Failure Long Term (ESC-HF-LT) Registry, which enrolled patients from April 2011 to February 2014. A total of 1661 HHF patients from Egypt were enrolled, of whom 1645 were eligible for analysis: 914 from Alexandria, 249 from Cairo, 409 from the Delta region, and 73 from Upper Egypt.
The mean age ranged from 52.2 to 62.8 years and differed significantly between the 4 groups (
P
< 0.01). Females represented one-third of the cohort (
P
= 0.5 between groups). The prevalence of obesity, diabetes, and hypertension also varied significantly across the groups (
P
< 0.01). The most common etiology of heart failure (HF) was ischemic heart disease. HF with reduced systolic function was the leading type of HF in the 4 groups (
P
= 0.6). The most common valvular abnormality in all regions was mitral regurgitation. For patients with prior history of HF, community-acquired infection was the most common reason for a HF exacerbation in all 4 groups.
In-hospital mortality ranged from 2.9 to 7.7% in the 4 groups (
P
= 0.06). Only Alexandria and Delta groups provided reliable 1-year follow-up data, given low patient retention in Cairo and Upper Egypt groups. At one-year, 32% of patients from Alexandria compared to 22.6% from Delta were re-hospitalized for HF (
P
< 0.01). Mortality at 1 year was also significantly higher in Alexandria compared to Delta, 31.8 vs 13.2% respectively (
P
< 0.01).
Conclusions
HHF patients from different geographic regions of Egypt differed significantly in their demographics, clinical characteristics, and outcomes. Those differences underscore the importance of region-specific HF prevention and management strategies.
Background
Knowledge of the frequency of precipitating factors for acute heart failure (AHF) is important (either new-onset heart failure NOHF or worsening heart failure WHF), as this can guide ...strategies for prevention and treatment. Most data come only from Western Europe and North America; nevertheless, geographic differences do exist. We set out to study the prevalence of precipitating factors of AHF and their connection to patient characteristics and in-hospital and long-term mortality in patients from Egypt hospitalized for decompensated HF. Using the ESC-HF-LT Registry which is a prospective, multicenter, observational study of patients confessed to cardiology centers in the nations of Europe and the Mediterranean, patients presenting with AHF were recruited from 20 centers all over Egypt. Enrolling physicians were requested to report possible precipitants from among several predefined reasons.
Results
We included 1515 patients (mean age 60 ± 12 years, 69% males). The mean LVEF was 38 ± 11%. Seventy-seven percent of the total population had HFrEF, 9.8% had HFmrEF, and 13.3% had HFpEF. The commonly reported precipitating factors for AHF hospitalization among study population were as follows (in decreasing order of frequency): infection in 30.3% of patients, acute coronary syndrome/myocardial ischemia (ACS/MI) in 26%, anemia in 24.3%, uncontrolled hypertension in 24.2%, atrial fibrillation (AF) in 18.3%, renal dysfunction in 14.6%, and non-compliance in 6.5% of patients. HFpEF patients had significantly higher rates of AF, uncontrolled hypertension, and anemia as precipitants for acute decompensation. ACS/MI were significantly more frequent in patients with HFmrEF. WHF patients had significantly higher rates of infection and non-compliance, whereas new-onset HF patients showed significantly higher rates of ACS/MI and uncontrolled hypertension. One-year follow-up revealed that patients with HFrEF had a significantly higher rate of mortality compared to patients with HFmrEF and HFpEF (28.3%, 19.5, and 19.4%,
P
= 0.004). Patients with WHF had a significantly higher rates of 1-year mortality when compared to those with NOHF (30.0% vs. 20.3%,
P
< 0.001). Renal dysfunction, anemia, and infection were independently connected to worse long-term survival.
Conclusions
Precipitating factors of AHF are frequent and substantially influence outcomes after hospitalization. They should be considered goals for avoiding AHF hospitalization and depicting those at highest risk for short-term mortality.
This report describes the case of a 13-year-old male patient presenting with functional small bowel obstruction. The child was also observed to have persistent tachycardia, and repeat cardiac ...examination revealed a new-onset cardiac murmur and a gallop rhythm. Acute viral myocarditis was clinically suspected, prompting further cardiac evaluations including electrocardiogram (EKG), echocardiogram (echo), and cardiac enzyme panel. Both EKG and echo findings suggested acute myocardial injury, in addition to elevated levels of cardiac enzymes and other inflammatory markers. Considering the ongoing pandemic, coronavirus disease 2019 (COVID-19) infection was suspected, but reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. Because multisystem inflammatory syndrome in children (MIS-C) may occur later in the course of COVID-19 illness, a SARS-CoV-2 antibody test was performed, with positive results. To our knowledge, this is the first pediatric case of COVID-19 presenting as functional intestinal obstruction. We present this case to share our findings on this unique manifestation of COVID-19 with pediatric colleagues. We also engage in a brief review of MIS-C.
Shea butter is becoming increasingly popular in foods, cosmetics and pharmaceutical products. This work aims to study the effect of the refining process on the quality and stability of fractionated ...and mixed shea butters. Crude shea butter, refined shea stearin, olein and their mixture (1:1
/
) were analyzed for fatty acids, triacylglycerol composition, peroxide value (PV), free fatty acids (FFA), phenolic (TPC), flavonoid (TFC), unsaponifiable matter (USM), tocopherol and phytosterol content. Additionally, the oxidative stability, radical scavenging activity (RSA), antibacterial and antifungal activities were evaluated. The two main fatty acids in the shea butter samples were stearic and oleic. The refined shea stearin showed lower PV, FFA, USM, TPC, TFC, RSA, tocopherol and sterol content than crude shea butter. A higher EC50 was observed, but antibacterial activity was much lower. The refined olein fraction was characterized by lower PV, FFA and TFC in comparison with crude shea butter, but USM, TPC, RSA, EC50, tocopherol and sterol content was unchanged. The antibacterial activity was higher, but the antifungal activity was lower than those of crude shea butter. When both fractions were mixed, their fatty acid and triacylglycerol composition were similar to those of crude shea butter, but other parameters were different.
ABSTRACTObjectives Coronary artery thrombus burden (TB) is one of the risk factors for major adverse cardiovascular events (MACE) in patients with acute ST segment elevation myocardial infarction ...(STEMI). It was discovered that there is a strong relationship between epicardial adipose tissue (EAT) thickness and the incidence of coronary atherosclerosis. The aim of our study is to evaluate the relationship between EAT thickness and coronary TB in patients with STEMI treated with primary percutaneous coronary interventions (PPCI).Methods The study included 80 patients presented with acute STEMI and treated by PPCI; their mean age was 54.35 ± 8.80 years, and 70 (87.5%) were males. Patients were divided into 2 groups according to the degree of TB: group I (25 patients) with low TB and group II (55 patients) with high TB. The EAT thickness was measured by 2D-echocardiography in all patients.Results We found that EAT thickness was significantly higher in group II compared to group I (p < 0.001), and theROC curve cutoff point value of EAT thickness equal to or greater than 2.48 mm could predict high TB in patients with STEMI (p < 0.001), and by multivariate analysis, EAT thickness was the most significant predictor of high TB.Conclusions In STEMI patients undergoing primary PCI, the increased EAT thickness measured by 2D echocardiography is significantly associated with a high coronary artery thrombus burden.
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